The document discusses household air pollution from inefficient use of energy in homes. It notes that women and children in developing countries are most exposed and at risk of disease. Common diseases caused by household air pollution include acute lower respiratory infections, chronic obstructive pulmonary disease, lung cancer, heart disease and stroke. WHO estimates 4.3 million deaths per year are attributable to household air pollution. WHO is addressing this issue through new indoor air quality guidelines, recommendations to transition to cleaner fuels and technologies, and efforts to harmonize with other global initiatives focused on sustainable energy access and climate change mitigation.

1. HAP: the Growing Burden of Disease | 15 July 20151 |
Health Impacts of Household Energy Use
Heather Adair-Rohani
Photo courtesy of: Ajay
Pillarisetti

2. Health Impacts of household energy use2 |
Overview of presentation
 Who are the most exposed to household air pollution?
 What are the health impacts from the inefficient use of
energy in the home?
 Where does the household air pollution go?
 Why are there differing numbers/figures for household
air pollution exposure and disease burden?
 How is WHO addressing the household air pollution?

3. Health Impacts of household energy use3 |
Household Air Pollution (HAP)
 Household air pollution arises from the
incomplete combustion of fuels used in
or around the home for cooking,
heating, lighting and other household
energy end-uses.
 It is not the fuel itself that leads to
household air pollution, but rather it is
the efficiency and characteristics (e.g.
chimney) of the energy technology in
combination with the fuel that impacts
the level of household air pollution.

4. Health Impacts of household energy use4 |
WHO ARE THE MOST EXPOSED TO
HOUSEHOLD AIR POLLUTION?

5. Health Impacts of household energy use5 |
Who are the most exposed and at risk for ill health
from household air pollution?
 Populations living in low and
middle-income countries
 Women and children are the
most exposed to household air
pollution
 Both rural and urban populations
 Health relative risks are higher
for women

6. Health Impacts of household energy use6 |
Household Air Pollution (HAP) Exposure, 2012

7. Health Impacts of household energy use7 |
Regional HAP Exposure, 2012
 2.9 billion people
exposed or…
 42% of the global
population
 Over time the %
exposed has
decreased, but the
absolute # of people
exposed has
remained the same
78%
15%
34%
12%
63%
45%
0%
0% 20% 40% 60% 80% 100%
Afr
Amr
Emr
Eur
Sear
Wpr
HIC
Population Primarily Cooking with Solid Fuels

8. Health Impacts of household energy use8 |
WHAT ARE THE HEALTH IMPACTS FROM
THE INEFFICIENT USE OF ENERGY IN THE
HOME?

9. Health Impacts of household energy use9 |
Health Impacts: Particulate Matter (PM)
Outdoor Air Pollution
PM is a complex mixture of chemical components that have diverse
chemical & physical characteristics that can impact health such as
size, particle core chemistry, metals, biogenic origin etc.
The harmful effects of PM arise from the particle’s presence on
biological tissues, to the actions of chemical constituents,
including absorded components or a combination of these factors.
These toxic effects include:
• bronchial irritaion
• inflammation,
• genotoxic events (i.e. carcinogenic)
• reduced macrophage response

10. Health Impacts of household energy use10 |
HOUSEHOLD AIR POLLUTION
1. Outdoor Air Pollution
Medgadget .com
PM2.5
CO
PAH
CH4
CH2O
NOx
SOx
NMVOCs

11. Health Impacts of household energy use11 |
PM Across Combustion Sources
Outdoor air
pollution (green)
Household air
pollution (red)
Second-hand
smoking (blue)
*Burnett et al EHP 2014

12. Health Impacts of household energy use12 |
What diseases are associated with
household air pollution exposure?
Disease outcomes:
 Acute Lower Respiratory Infections (ALRI);
 Chronic Obstructive Pulmonary Disease (COPD);
 Lung Cancer (Biomass + Coal);
 Ischaemic Heart Disease (IHD)
 Stroke
 Cataract

13. Health Impacts of household energy use13 |
What diseases are associated with
household air pollution exposure?
Disease outcomes:
 Acute Lower Respiratory Infections (ALRI);
 Chronic Obstructive Pulmonary Disease (COPD);
 Lung Cancer (Biomass + Coal);
 Ischaemic Heart Disease (IHD)
 Stroke
 Cataract
 Adverse pregnancy outcomes
 Tuberculosis
 Cognitive development
 Other cancers (cervical, upper aero-digestive)

14. Health Impacts of household energy use14 |
•Health risks extend beyond diseases outcomes
•Women & children are at more risk for burns &
scalding, as well as vulnerable to attack and
injury during fuel collection
•Kerosene consumption is one of the leading
causes globally of childhood poisonings
•Additional health impacts from the climate
change caused by inefficient energy use like
changes in precipitation, drought, temperatures,
etc.

15. Health Impacts of household energy use15 |
Household Air Pollution & Global Impacts on Health
In 2012, 2.9 billion
people primarily
used solid fuels
for cooking
 4.3 million deaths a year from
household air pollution—the
largest environmental risk
factor for disease
 Accounts for over half of
childhood pneumonia deaths
(the largest cause of death in
children under 5 years)
 A major cause on NCDs (e.g.
COPD, heart disease, stroke,
lung cancer)

16. Health Impacts of household energy use16 |

17. Health Impacts of household energy use17 |
Deaths per capita attributable to HAP in
2012, by region

18. Health Impacts of household energy use18 |
Deaths attributable to HAP in 2012, by
disease
• 88% of HAP attributable
burden is to non-
communicable diseases
• Over 50% of all ALRI
deaths in children under
five years of age are
attributable to HAP
547,904
13%
273,391
6%
927,844
22%
1,463,024
34%
1,096,249
25%
ALRI
Lung cancer
COPD
Stroke
IHD

19. Health Impacts of household energy use19 |
WHERE DOES THE HOUSEHOLD AIR
POLLUTION GO?

20. Health Impacts of household energy use20 |
Joint Effects: Disease Burden from
Household AP + Ambient AP (AAP), 2012
 In some areas, a significant fraction of ambient air pollution
(AAP) is caused by household fuel combustion
 Around 400,000 of the ambient air pollution deaths are
caused by household air pollution “leaking” outdoors.

21. Health Impacts of household energy use21 |
WHY ARE THERE DIFFERING
NUMBERS/FIGURES FOR HOUSEHOLD AIR
POLLUTION EXPOSURE AND DISEASE
BURDEN?

22. Health Impacts of household energy use22 |
Previous WHO estimates
• In 2002, WHO estimated that 2.7 billion
people were exposed to household air
pollution (vs. 2.9 billion in 2012)
• In 2002, approximately 2 million deaths-
~900,000 to COPD, ~1 million to ALRI,
and 100k to lung cancer from coal use
(vs. 4.3 million deaths in 2012)

23. Health Impacts of household energy use23 |
What accounts for the big increase?
• Underlying population & mortality
estimates
• Disease outcomes accounted for
• Risk estimates – methods & values
• Methods assessing exposure

24. Health Impacts of household energy use24 |
Lots of numbers but same MESSAGE
BIG EXPOSURE
+
BIG DISEASE BURDEN
=
MAJOR PUBLIC HEALTH
ISSUE

25. Health Impacts of household energy use25 |
HOW IS WHO ADDRESSING HOUSEHOLD
AIR POLLUTION?

26. Health Impacts of household energy use26 |
WHO RESOLUTION: Health and the Environment:
Addressing the health impact of air pollution
(WHA68/A/CONF./2 Rev.1)
 Highlights the key roles that national and local health authorities
need to play in raising the awareness about the health impacts of
air pollution
 Call for multi-sectoral action to address air pollution
 Urges MS to develop and enhance air quality and health
monitoring systems
 Promote clean fuels and technologies, in addition to sharing of
international expertise, technologies and scientific data
http://apps.who.int/gb/ebwha/pdf_files/WHA68/A68_ACONF2Rev1-
en.pdf

27. Health Impacts of household energy use27 |
WHO
Guidelines for Air
Quality

28. Health Impacts of household energy use28 |
Previous Air Quality Guidelines – how they relate
to new Indoor Air Quality Guidelines
Pollutant Guideline or
target
Exposure
period
Level (µg/m3)
PM2.5
(2005)
Guideline Annual
average
10
IT-3 15
IT-2 25
IT-1 35
Pollutant Guideline or
target
Exposure
period
Level (mg/m3)
Carbon
monoxide
(2010)
Guideline 8-hour 10
Guideline 24-hour 7

29. Health Impacts of household energy use29 |
WHO Guidelines for Indoor Air Quality:
Household Fuel Combustion
What do they tell us…
• How clean is clean enough
• What fuels shouldn’t be used
• All end-uses (e.g. cooking,
heating, lighting) need to be
clean
• Transition to clean will take
time & vary across settings
• Climate co-benefits

30. Health Impacts of household energy use30 |
IER function for PM2.5 and child ALRI risk (linear scale)
WHO IT-1 (35
µg/m3 PM2.5)

31. Health Impacts of household energy use31 |
WHO IAQG: Household fuel combustion
Recommendation 1(a) Emission rate targets
emission,2.5of homes to meet the WHO AQGs for PM%90For
rates should not exceed the emission rate targets (ERTs) set out
below.
Emissions rate
targets (ERT)
Emission rate
(mg/min)
Percentage of
kitchens meeting
AQG (10 µg/m3)
Percentage of kitchens
meeting AQG IT-1 (35
µg/m3)
Unvented
Intermediate 1.75 9% 60%
Final 0.23 90% 100%
Vented
Intermediate 7.15 4% 60%
Final 0.80 90% 100%

32. Public health and environment32 |
Rec 2: Household energy transition
Urban and
peri-urban
2015 2020 2025 2030
Rural
better-off
Rural poor
Clean
fuel
Traditional
biomass
Low emission
biomass
To ensure ‘best possible’
• Testing
• Standards
• Certification

33. Health Impacts of household energy use33 |
WHO IAQG: Household fuel combustion
Recommendation 3:
Unprocessed coal should not be used as a household
fuel
Recommendation 4:
Household combustion of kerosene is
discouraged while further research into its health
impacts is conducted

34. Public health and environment34 |
Good Practice Rec: Securing health and climate co-
benefits
Recommendation:
Considering the opportunities for synergies between
climate policies and health, including financing–
governments and agencies who develop & implement
policy on climate change mitigation should consider
action on household energy and carry out relevant
assessments to maximize health and climate gains.

35. Public health and environment35 |
Supporting implementation in countries
COUNTRY
Survey and AQ
measurement tools
HAPIT tool
Emissions model
Adoption tool
Needs
assessment
and mapping
M&E strategy,
capacity and
resources
Intervention
options
assessment
Policy (finance,
market, &c.) for
adoption and
sustained use
Standards,
testing and
certification
ACTION PLAN
Multisectoral ‘task
group’

36. Health Impacts of household energy use36 |
Synergies: Harmonizing Efforts Across
Initiatives
WHO
IAQG
ISO/IWA
Standards
SE4All
Multi-tier
tracking
framework
GACC
Clean
cooking
catalogue
Post-
2015
SDGs
HARMONIZATION

37. Health Impacts of household energy use37 |
How WHO is working on domestic energy needs?
Clean Home Energy Solutions
 Raising awareness and supporting the
tracking, monitoring & evaluation of health
impacts from home energy
– Global databases on household air pollution
measurements & solid fuel use in the home
– Field research on the health impacts of various
interventions (e.g. LPG, “improved” stoves)
– Tracking the health effects of other domestic
energy needs (e.g. lighting, heating)

38. Health Impacts of household energy use38 |
How WHO is working on domestic energy needs?
Clean Home Energy Solutions
 Connecting WHO’s AP work to other global work on
home energy, sustainable development & climate
– Global Alliance for Clean Cookstoves (GACC)
– UN Secretary General’s Sustainable Energy for All
initiative (SE4All)
– Climate & Clean Air Coalition on Short-Lived Pollutants
(CCAC)
– WHO’s Global Platform for Air Quality & Health

39. Health Impacts of household energy use39 |
THANK YOU & ANY QUESTIONS